Balance and Falls SIG
Fall Prevention Programs Across the Care Continuum by Jennifer Gindoff, PT, DPT, DHSc; Jennifer L. Vincenzo, PT, MPH, PhD; and Heidi Moyer, PT, DPT The Balance and Falls Special Interest Group (SIG) of APTA Geriatrics consistently strives to meet the needs of our members. One such need is fielding specific questions received via email related to balance and falls management in the older adult population. Our research liaison, Jennifer Gindoff, continues to dive through the literature to answer these questions, providing a concise summary of her findings. Recently we received the following request. Member request: “I’m looking for any resources on fall prevention policy/ programs for acute and out-patient settings. Specifically interested in programs that support a continuum of care with the transition between the 2 settings. If you have resources, please share.” Dr. Gindoff’s reply: While many community-based and clinical programs exist to manage falls in various populations, there is a dearth of evidence for programs that span multiple settings of care acuity. Most of the research is siloed. The focus in acute care is on identifying individuals at risk of falls and providing appropriate supervision, environmental modification, and staff and patient education (as those are considered the primary risk factors). Fall prevention research in the community focuses on promoting understanding of risk factors and increasing exercise through community-based programming. An editorial by Hicks (2019)1 described studies addressing evidence-based strategies to reduce the risk of falls and reported that there have been no gold standard or specific exercises identified that address this issue (at time of publication). Falls among older adults have been a well-documented public health concern for several years. Cheng et al. 2 completed a meta-analysis in an effort to identify effective fall prevention programs and found, when compared to usual care, the only effective interventions at reducing fall rates were risk assessment, exercise, and multifactorial interventions (defined as 3 or more interventions). However, some comparisons were not statistically significant due to small sample sizes. Thompson et al.3 examined the effectiveness of a 12-week multidimensional exercise program in older adults with regard to improving balance and reducing fall risk and found significant improvements in TUG scores, functional reach ability, and 30 second chair rise scores. While it is helpful to know that multimodal exercise programs reduce fall risk, this is not new
GeriNotes • March 2022 • Vol. 29 No. 2
information and, from a clinical perspective, not inherently helpful as it remains unclear what specific activities within a multifactorial approach are the most effective. The efficacy of a multimodal approach may be due to a number of factors such as the use of components that are in-and-of themselves effective, the interaction of interventions, or increased likelihood of success that the provided interventions will target the fall risk factors in a specific individual.2 Therefore, in the quest for clarity regarding fall prevention interventions, literature on some existing community-based fall prevention programing was reviewed to determine if physical therapists could, perhaps, plant the seeds early (even in the acute care phase) with the intention of preparing patients to eventually participate in an organized program later. Balance programs The National Council on Aging (NCOA) recommends a number of fall prevention programs with various target audiences and dissemination methods.4 Using information available from NCOA in 2016, Walters et el.5 listed 4 fall prevention programs which will be discussed here: Otago, Stepping On, Matter of Balance, and Tai Ji Quan: Moving for Better Balance. According to Coe et al,6 Matter of Balance (MOB) received the most referrals, enrollments, and completions of the available fall prevention programs studied. The MOB is reported to be among the top 3 fall risk programs and has the most evidence to support its effectiveness.7 Matter of Balance (MOB) MOB is an evidence-based program consisting of eight, 2-hour sessions designed to reduce fear of falling, increase physical activity levels in order to enhance fall self-efficacy, and promote exercises that increase strength, flexibility, stamina, and balance.8 Small group activities including discussions, lectures, role play, exercise training, and mutual problem solving are basic to MOB; weeks 1-3 consist of cognitive behavioral strategies to support behavior change and weeks 4-8 focus on fall habits, fall prevention, and exercise.5,9 Significantly improved self-reported health, decreased fear of falling, reduced fear of falling that interfered with activity, and improved activity levels for 4296 community dwelling older adults who attended the program were reported in one study.10 Additionally, fall rates were reduced by 62% and injurious falls by 74%; program completion rate was 97.25%.10 Matter of Balance is well received and reduces fear of falling and fall risk.5,7,9,10 Some literature suggested that physical activity levels improve post MOB.9,10 How-
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